In this article...
On the morning of Saturday, Feb. 21, 2004, six days after his 54th birthday, my father, Jorge A. Bañales, woke up early, as he usually does, and prepared for his TaiChi classes at a nearby park.
Seated in his car he felt some discomfort in his chest, but didn't give it much thought and began to drive. Within a few blocks the pain intensified and he noticed numbness in his left arm. As a fitness instructor, he had taken cardio-pulmonary resuscitation (CPR) classes so he recognized the symptoms immediately.
My dad was having a heart attack.
He was somewhat disoriented as he tried to make his way to the nearest hospital, but eventually managed to flag down a police car who in turn called an ambulance. During the ambulance ride, medics initiated treatment. In the emergency room, doctors performed an angioplasty through his right femoral vein without an anesthetic, because his blood pressure was very low.
Born in Uruguay, my father has lived in the United States since 1982. He clearly remembers the details of that fateful day.
"I remember the room, the monitors that were on my left where I could see images of the procedure. I remember the movement of the coronary arteries with each heartbeat, and the voice of one of the techs who indicated that I 'was going down'". I remember the palpitations becoming slower and weaker and the cardiologist's instructions," he says. "They implanted two stents in the left anterior artery. Then I was put in the recuperation room and was discharged on Monday morning."
My dad saved his life because he recognized the symptoms of a heart attack and acted quickly to get help.
According to a study titled "Awareness of heart attack and stroke symptoms among Hispanic male adults living in the United States," published in the Journal of Immigrant and Minority Health (JIMH) in October, 2010, far too many Hispanic men are "a high risk group for treatment delay for both heart attack and stroke." The study recommends that "more targeted research is needed to elucidate this specific population's knowledge of warning signs for these acute events."
The research participants were U.S. male Hispanic adults ages 18–99 and the study revealed that only 34.6 percent knew that pain or discomfort in the jaw, neck or back are symptoms of a heart attack and that 44.1 percent incorrectly thought sudden trouble seeing in both eyes was a symptom of a heart attack. "In addition, 37.7 percent responded incorrectly to the question regarding feeling weak, lightheaded, or faint as symptoms of heart attack." Nearly 10 percent failed to recognize that calling 911 was the appropriate first response to these acute events.
Though a healthy diet and moderate exercise are important, my dad is one example of how they are not always enough to avoid heart disease.
"My lifestyle was and is reasonable healthy. I wasn't overweight, but I did smoke one or two cigarettes a day -- sometimes I didn't smoke for days - but at the time I was smoking more than what was usual for me," he said. "I've always engaged in some kind of physical activity. I'm a TaiChi instructor which means I practice on my own every day and practice with students when I teach."
Still, he admits there were early signals.
"For many years I had awakened in the middle of the night feeling my hands and arms numb. Annual medical exams had indicated for many years high levels of cholesterol and triglycerides. I lowered my consumption of sweets, and I adapted my diet [according] to what the doctors told me. The problem was genetic [and caused by] the cholesterol produced by my body plus the cholesterol found in the foods I consumed," my father said.
In the years leading up to the heart attack he says he underwent several life-changing and stressful events, which caused him to struggle with depression. In 2000, he collapsed at work and at the clinic he was told he was having heart attack symptoms and was sent to the hospital where, after some exams, he was released without a definitive diagnosis.
Following his heart attack he was told to rest, but he returned to the hospital by ambulance some 10 days later when he started feeling chest pains again. As a precaution, hospital doctors introduced a catheter-this time through the left femoral vein-to determine if there was obstruction of the stents, but discharged him the next day.
For the next several months, my father followed a self-imposed regimen of diet and exercise. A year later he got a gym membership and took it upon himself to complete a lighter version of an exercise routine that he had found in a book. Throughout January, he kept up with the exercises and completed 80 percent of his goals.
"As years have passed I've undergone other angiographies, my drugs have changed, and I exercise more," he says. "I smoke a little bit, and I try to drink a glass of wine each night."
He currently takes asprin, blood thinners and four prescribed medications to lower his cholesterol and blood pressure.
He says that his lifestyle has not changed much. He still works eight hours a day at a job that requires him to wake up at 4:00 in the morning. He also freelances doing translations, and teaches TaiChi four hours a week.
"What has changed is how I approach life," he says. "Since the heart attack, I have lost the notion of the future. It's very hard for me to plan something for the next two weeks; and something that will occur in a month is very remote for me. It's as if I live for today, tomorrow and the next day."
"Without it being a depressing or somber thought, I consider it very possible that this might be my last day; I live as if I was to die at any moment, and I find this extremely liberating."
He says he has taken steps to make life less stressful. He is no longer nostalgic about the past and this has given him yet another sense of freedom.
"In so far as I can do something to lower my cholesterol, I do it - drugs, diet, exercise - but I think the biggest difference in my life is how I handle stress", he says.
"I don't get anxious about losing too much in the future. I've already lost some things and I still survived."
Hispanics are the fastest growing population in the country and have surpassed all other racial or ethnic groups to become the largest minority in the United States. There are more than 30 million Hispanics in the U.S. and the group is on track to constitute 24 percent of the population by 2050.
However, the JIMH study says there is scant epidemiological information that focuses on the incidence rates of heart attack and stroke for this population. The available evidence suggests that complications and death from stroke disproportionately affect Mexican-Americans, the largest U.S. Hispanic subgroup.
"Every time I look at the calendar, I’m surprised that in a short time, it will be seven years since I almost died, and I’ve had more than 2,500 additional days since then,” my father said.
"It's enough to make one feel better."
Cardiovascular diseases, including stroke, are the number one cause of death in the United States. According to the American Heart Association, in 2004 nearly one in three, or 79,400,000 U.S. adults, had one or more types of cardiovascular diseases (CVD) and approximately 20 percent of those with CVD had coronary heart disease (CHD). Among those with CHD, almost 8 million experienced a heart attack while another 8,900,000 experienced chest pain. Among adult Non-Hispanic whites, the estimated CHD – heart attack and chest pain -- prevalence is 6.6 percent.
However, the American Heart Association indicates that only 9.2 percent of U.S. Hispanic or Latino adults were estimated to have heart disease, and 6.0 percent had CHD.
The Center for Disease Control and Prevention [PDF | 1.6MB] says that, in general, Hispanic American adults are 10 percent less likely to have coronary heart disease than non-Hispanic white adults. In 2009, the age-adjusted percentages of coronary heart disease among people 18 years of age and older were 5.8 percent for Hispanics and 6.5 percent for non-Hispanic whites. They are also less likely to die from heart disease than non-Hispanic white adults. In 2007, Hispanic men and women were 30 percent less likely to die from heart disease, compared to non-Hispanic whites. Mexican American women are 20 less likely to have high blood pressure than non-Hispanic White women.
Centers for Disease Control and Prevention [PDF | 10.3MB] numbers show however, that compared to Non-Hispanic white men, Mexican American men have increased rates of high cholesterol, which is one indicator of potential heart disease. Between 2003 and 2006, the age-adjusted percentages of persons 20 years of age and older who had high cholesterol were 17.6 for Mexican American men compared to 15.1 Non-Hispanic white men.
But despite the lower incidence of heart disease among Hispanics, the Agency for Healthcare Research and Quality indicates that Hispanics are less likely to measure their blood cholesterol. In 2003, 68.4 percent of Hispanics had been screened, compared to 73.4 of Hon-Hispanic whites.
Your Guide to Lowering Your Cholesterol with TLC (Therapeutic Lifestyle Changes) [PDF | 1.7MB]
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